Industry Newsmaker

The Inevitable Shift to Value

CareCentrix CEO explains why fee for service will soon be a thing of post-acute care’s past.

The post-acute care space is in a massive stage of change, and John Driscoll is watching that change very carefully. As CEO of CareCentrix, Driscoll oversees a company that provides a wide network for the world of post-acute care.

Consider CareCentrix a sort of matchmaker that connects healthcare plans, referral partners, care providers and HME businesses to help ensure that patients enjoy successful outcomes and independent lifestyles in their homes, as opposed to the hospital. The idea is to connect various care entities involved in the homecare setting to help patients transition from hospitals or skilled nursing facilities into the home, and ensure that they have the right care, services and medical equipment in place. The network even offers specialized “offshoots” for specialized homecare options such as sleep therapy and infusion.

And the statistics are with CareCentrix — and the HME industry. The company cites a number of key data points explain to healthcare plans why it is so important to get patients into successful homecare settings: 75 percent of costly hospital readmissions are preventable; 40 percent of patients discharged to long-term acute care hospitals didn’t need to be. 

Driscoll’s no stranger to post-acute care, health plans and services, and healthcare technology. He’s racked up more than 25 years’ experience at firms such as healthcare technology company Castlight Health, and $70 billion pharmacy benefit management company Medco. He also founded and chaired the Surescripts ePrescribing Network, which established the first cross-industry collaborative involving competing retail, PBM, and health plans cooperating to revolutionize e-prescribing. In terms of scale, Surescripts went from servicing under 50 million prescriptions in 2005, to more than 1 billion prescriptions today.

So, suffice it to say that Driscoll not only understands the waves of change in the healthcare marketplace, he’s ridden them like a pro surfer. And like a big wave forming at California’s Mavericks or Hawaii’s Jaws, the next major swell he sees mounting on the horizon is the end of fee for service, and he advises that providers better paddle out ahead of that wave.

“At CareCentrix we’re increasingly seeing with our provider partners a willingness and an interest in partnering in our value-based solutions,” he says. “The fee-for-service world will be increasingly dicey, not just for DMEs, but for all fee-for-service providers, because the one thing that the Republicans and the Democrats appear to agree on is a long-term shift for value. The terms may change, but that wave, it’s likely to be relentless and get bigger and faster.”

That’s why CareCentrix is reaching out to DMEs to be part of the network of post-acute resources that it is building.

“We believe that the shift to value is inevitable and will be helpful,” Driscoll says. “We believe that, CareCentrix’s approach, while we are the agent of managed care, we want to be a partner to the providers.

“Long-term, value-based solutions are going require some of the things that we do at CareCentrix,” he says. “We need to connect the providers to the time manager or the risk taking entity and to engage the best providers and actually measure yourself against more traditional consumer metrics. So the skills to compete and win in a value-based world may not be well-defined in Washington, but we, but we’re seeing the marketplace today with defined success.”

The big question is how will the value of service and care be defined, if it is no longer based on fee for service. That part of the wave is still taking shape, according to Driscoll.

“I don’t think the picture’s clear, but the ‘contour lines’ are emerging,” he says. “It’s going be based around total medical cost, the data around clinical outcomes, and the data around patient satisfaction.

“… We are investing deeply in a, in a differentiated analytical, machine- learning platform that will allow us to provide more information to the plan but also to the providers,” he continues. “And allow us to make better decisions clinically in the field around which providers to use and which bundles of services are going be more effective to allow people to heal and age in the home.”

Of course, the next step is getting providers involved in CareCentrix’s network, and Driscoll says his company is actively looking to find the right HME partners.

“… We’re spending a lot of time to determine which providers want to participate with us on a performance basis,” he says. “Because ultimately we’re all going to be performance-based providers in a value-based world.” n


About the Author

David Kopf is the Editor of HME Business.

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